Currently, i am half way completed with my final clinical affiliation. As a student working hand in hand with a very experienced Emergency Department CI I have come to the realization that I don't know much at all. In the ED, we often have very little pt information and are further restrained by time constraints.

My clinical mindset has adapted to the VINDICATE-P (vascular, infection, neoplasm, drugs, inflammation, congenital, autoimmune, trauma, endocrine, and psychosocial) system of evaluation. This system has helped me align my thoughts and lump S/S into a more ordered multi-linear state.

The Er physician typically sees the pt first and will consult me (and my CI) when deemed appropriate. These consults may range from LBP, WAD injuries, and Fx to BPPV, wound care and mobility assessments post CVA, or other neurological infarct. I typically make recommendations to the physician and it is carried out immediately.

With autonomy of practice gaining momentum I feel that the 'average' clinician should be comfortable with the above. It would be ideal to have autonomy for the following: ordering imaging, ordering walkers/canes/tens units, writing 'Dr's notes', prescribing pain medications.

As a student whom is about to enter the work force I am still unsure of my clinical skill set. I question my understanding of polypharmacy interactions, as well as my knowledge base of systemic diseases (and related musculoskeletal symptoms).

What are your thoughts as ways to better prepare for a more autonomous practice?

Excellent question given your clinical rotation experience. Unfortunately the current PT educational model is not consistent across the board in terms of what is the ideal skill set that the PT of the future should posses! Thus creating this void of educational gaps, on the flip side you can say why should PT schools be concerned about teaching students about direct access skills when the definition of direct access has not been clearly defined, this definition varies greatly from state to state. Unless you land a sweet gig like the one youve described or work for the military, the likelihood of you putting such skills to use (n the manner youve described request imaging etc) will prob not happen. Nevertheless, I think all PTs should posses these skills set as these can be INDIRECTLY used in any OP-ortho setting. The best PT school that trains for the type of skills youve described is the Army-Baylor program, however there are ways in which you can bring your skills set close to that level. Imaging skils for example can be enhanced by attending various imaging courses available for PTs. I ve taken the APTAs two courses on imaging the most comprehensive beng the one by Lynn Mckinnis PT. Ive received post-graduate training through the Air Force, these training opportunites are also available to civilian PTs contracting with the military If autonomy is what you want then pursue ED work or even better OP ortho in the military.